How Does Use of a Prescription Monitoring Program Change Medical Practice?

OBJECTIVES: The objectives of this study were to test for differences in prescription monitoring program (PMP) use between two states, Connecticut (CT) and Rhode Island (RI), with a different PMP accessibility; to explore use of PMP reports in clinical practice; and to examine associations between PMP use and clinician's responses to suspected diversion or "doctor shopping" (i.e., multiple prescriptions from multiple providers). DESIGN, SETTING, SUBJECTS: From March to August 2011, anonymous surveys were emailed to providers licensed to prescribe Schedule II medications in CT (N = 16,924) and RI (N = 5,567). OUTCOME MEASURES: PMP use, use of patient reports in clinical practice, responses to suspected doctor shopping, or diversion. RESULTS: Responses from 1,385 prescribers were received: 998 in CT and 375 in RI. PMP use was greater in CT, where an electronic PMP is available (43.9% vs 16.3%, χ(2) = 85.2, P < 0.0001). PMP patient reports were used to screen for drug abuse (36.2% CT vs 10.0% RI, χ(2) = 60.9, P < 0.0001) and detect doctor shopping (43.9% CT vs 18.5% RI, χ(2) = 68.3, P < 0.0001). Adjusting for potential confounders, responses by PMP users to suspicious medication use behavior were more likely to entail clinical response (i.e., refer to another provider odds ratio, OR, 1.75 95% confidence interval, CI, 1.10, 2.80; screen for drug abuse OR 1.93 1.39, 2.68; revisit pain/treatment agreement OR 1.97 1.45, 2.67; conduct urine screen OR 1.82 1.29, 2.57; refer to substance abuse treatment OR 1.30 0.96, 1.75) rather than legal intervention (OR 0.45 0.21, 0.94) or inaction (OR 0.09 0.01, 0.70). CONCLUSIONS: Prescribers' use of an electronic PMP may influence medical practice, especially opioid abuse detection, and is associated with clinical responses to suspected doctor shopping or diversion.